Myotonic Dystrophy

Myotonic Dystrophy

Ophthalmology Volume 118, Number 11, November 2011 caused this discrepancy, because as they admit, the spectrophotometer we used is highly accurate. O...

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Ophthalmology Volume 118, Number 11, November 2011 caused this discrepancy, because as they admit, the spectrophotometer we used is highly accurate. Our interest is solely scientific, not commercial, but naturally we do not want to cause detriment to anyone to offer incorrect information. Our manuscript that was published in January 2011 was submitted in November 2009, so the measurements were carried out toward the end of 2008 and beginning of 2009. Reviewing our database, we see that the intraocular lens (IOL) Physiol Slim Flex was measured under the same conditions as the other 10 IOLs included in our study and, as the results were somewhat surprising, the measurements were repeated but came out the same. Were the problem a question of an accidental tilt, the results would have been random, however, they were the same. Nonetheless, to recheck this, we requested further samples of the Physiol Slim Flex from the Physiol SA representative in Spain to measure it once again. We have measured these new lenses and now find that the transmission curve is as Pagnoulle et al1 say and not as we measured 3 years ago. In conclusion, we are practically sure that the measurements we made 3 years ago were correct. The Physiol Slim Flex IOL that was supplied to us recently, and which we measured a few days ago, has a different transmission curve from the IOL we measured 3 years ago. These findings confirm those described by Pagnoulle et al1 in their letter. We appreciate the interest in our research and are pleased to have the opportunity to confirm the new findings. JOSE M. ARTIGAS, PHD ADELINA FELIPE, PHD Valencia, Spain Reference 1. Artigas JM, Felipe A, Navea A, et al. Spectral transmittance of intraocular lenses under natural and artificial illumination: criteria analysis for choosing a suitable filter. Ophthlmology 2011;118:3– 8.

Myotonic Dystrophy Dear Editor: With interest we have read the article from Rosa et al.1 We agree that ciliary body detachment (CBD) is a frequent finding in eyes with ocular hypotony (Völcker et al2, 3). Following blunt or penetrating ocular trauma or surgery the sequence of events is clear; the unilateral CBD is a nonspecific complication that may further aggravate the persisting ocular hypotony. However, the data presented by Rosa et al do not prove that low intraocular pressure “results” from the usually bilateral CBD in myotonic dystrophy. The CBD just as likely might develop as a nonpathognomonic consequence of hypotony, a hen-egg-dilemma. Among other hypotheses, levels of gonadotropines have been studied and were confirmed to be increased; Küchle et al4 reported a significant correlation between luteinizing hormone and decreased intraocular pressure but no such correlation to follicle stimulating hormone was found. Khan and Brubaker5 observed no cause and effect relationship to aqueous humor dynamics. In our view, the pathogenesis of

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the puzzling ocular hypotony in myotonic dystrophy still is not known and remains to be clarified. Understanding this might be important for better understanding the factors influencing the ocular pressure. GOTTFRIED O.H. NAUMANN, MD Erlangen, Germany HANS-EBERHARD VÖLCKER, MD Heidelberg, Germany References 1. Rosa N, Lanza M, Borrelli M, et al. Low intraocular pressure resulting from ciliary body detachment in patients with myotonic dystrophy. Ophthalmology 2011;118:260 – 4. 2. Völcker HE, Naumann GOH. Morphology of uveal and retinal edemas in acute and persisting hypotony. Mod Probl Ophthalmol 1979;20:34 – 41. 3. Schmack I, Völcker HE, Grossniklaus HE. Phthisis bulbi. In: Levin LA, Albert DM, eds. Ocular Diseases- Mechanisms and Management. Philadelphia, PA: Saunders, Elsevier; 2010: 415–23. 4. Küchle M, Naumann GOH, Völcker HE, Sears ML. Hypotonia bulbi und gonadotropine bei myotonischer Dystrophie. Klin Monatsbl Augenheilkd 1988;193:388 –92 (in German with English summary). 5. Khan AR, Brubaker RF. Aqueous humor flow and flare in patients with myotonic dystrophy. Invest Ophthalmol Vis Sci 1993;34:3131–9.

Author reply Dear Editor: We thank Drs. Naumann and Volcker for their comments regarding our article. We agree with them that the presence of ciliary body detachment and ocular hypotony in some cases raises a “chicken or the egg” dilemma. Even if longitudinal studies should prove our statement, we believe, the finding of ciliary body detachment in myotonic dystrophy type 1 (DM1) patients with normal intraocular pressure (IOP) implies that ciliary body detachment precedes the onset hypotony. We have realized that there is a mistake in Figure 2 of the original manuscript. Patients with the IOP less than 10 mmHg were missing the original figure. A corrected figure is available in on line supplemental materials at http:// aaojournal.org. NICOLA ROSA, MD MADDALENA DE BERNARDO, MD MICHELE LANZA, MD Naples, Italy

Effects of VMA on anti-VEGF Treatment for ARMD Dear Editor: We read with great interest the study by Lee and Koh, entitled “Effects of vitreomacular adhesion on anti-vascular endothelial growth factor (VEGF) treatment for exudative age-related macular degeneration,” on the association between vitreomacular adhesion (VMA) and pharmacological resistance to anti-VEGF intravitreal injections for exudative age-related macular degeneration (AMD).1